Precision pharmacotherapy seeks to improve treatment selection and dosing by matching therapy more closely to biological characteristics, drug response, and individual risk. Yet biological appropriateness does not ensure that a patient can obtain, understand, monitor, sustain, or replace the recommended treatment. This Perspective argues that clinical pharmacology therefore requires a complementary concept of pharmacoequity: the condition in which biologically appropriate therapy can plausibly become realized therapeutic benefit because critical access and feasibility requirements are sufficiently aligned. The analysis integrates five clinically distinct domains—affordability, medicine availability, health literacy and treatment interpretability, monitoring access, and feasible treatment alternatives. Evidence across pharmacogenomics, medication-cost research, medicine shortages, health-literacy interventions, therapeutic drug monitoring, and shared decision-making indicates that each can modify the pathway between a technically appropriate prescription and its practical realization. These domains should not be treated as interchangeable, equally weighted, or uniformly causal. Their relevance depends on the medicine, disease, therapeutic window, duration and urgency of treatment, patient circumstances, local supply and financing arrangements, and the availability of clinically acceptable alternatives. The proposed pharmacoequity framework consequently extends precision pharmacotherapy without replacing biological criteria. It treats efficacy and safety requirements as noncompensatory clinical boundaries while asking whether an otherwise appropriate strategy is realistically deliverable and sustainable. The framework remains conceptual rather than validated and should initially be used to organize questions, expose hidden feasibility assumptions, and motivate prospective measurement rather than to generate scores or prescriptive thresholds.
